title: [A case of Wegener granulomatosis after treatment for non-tuberculous mycobacteriosis].
abstract: A 67-year-old woman with a history of non-tuberculous mycobacteriosis due to Mycobacterium avium in 2002 and 2006 was admitted because of low-grade fever and cavitary lesions in both lungs on chest computed tomography (CT). Bronchial brushing cytology by bronchoscopy did not yield mycobacterium. Her serum antineutrophil cytoplasmic antibodies (MPO-ANCA) level was elevated and PR3 ANCA was negative. A surgical lung biopsy revealed basophilic necrosis with cavitary lesions and necrotizing vasculitis compatible with Wegener granulomatosis (WG). In the resected specimen, several hyalinizing nodules with caseous necrosis, probably associated with previous mycobacterium infection, were also seen. Because her disease was limited to the lungs, we successfully treated her with corticosteroids and methotrexate. WG is considered to be a type of ANCA-associated vasculitis, and microbial infections have been associated with initiation and relapse of WG. This case clearly demonstrated that lesions of WG occurred after mycobacterial infection in the lung. We believe that this case was ANCA production in association with bacterial infection.
authors.affiliation: Department of Respiratory Medicine, Tokyo Rosai Hospital.
authors.forename: Munehisa
authors.initials: M
authors.lastname: Fukusumi
authors.forename: Kenji
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibata
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Aizawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sakai
authors.forename: Tamiko
authors.initials: T
authors.lastname: Takemura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tojima
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000209:etiology* / Q000276:immunology; D006801:Humans; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic